Occupational therapy (self-care training)
Facility: Davis County Hospital
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $70
- Cash Discount Price: $117
- vs. Medicare Baseline: 2.16x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Understanding this gauge: We use the federal Medicare rate of $32.4 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 216% of the Medicare baseline (a markup of 116%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Aetna | $58 | 179% |
| Choicecare Mcr Adv | $63 | 194% |
| Home State Hlth Exch - All Other Plans | $63 | 194% |
| Home State Hlth Mcr | $63 | 194% |
| Mt Carmel Hp-All Plans | $63 | 194% |
| Tricare | $63 | 194% |
| Amerigroup Mcr Adv-All Other Plans | $64 | 198% |
| American Hp Mcr Adv-All Plans | $66 | 204% |
| Home State Hlth Mcaid | $70 | 216% |
| Iowa Total Care Mcaid-All Plans | $72 | 222% |
| Amerigroup Mcaid | $73 | 225% |
| Molina Mcaid-All Plans | $73 | 225% |
| Midlands Choice - All Plans | $82 | 253% |
| Preferred Hlth Choices - All Plans | $88 | 272% |
| Choicecare Comm - All Other Plans | $111 | 343% |
| Blue Cross Blue Shield | $128 - $141 | 395% |